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Introduction: Social determinants of health (SDoH) impact patients’ health outcomes, yet screening methods in emergency departments (ED) are not consistent or standardized. The SDoH-related health disparities may have widened during the coronavirus 2019 (COVID-19) pandemic, especially among patients who primarily receive their medical care in EDs. We sought to identify SDoH among ED urgent care patients during the COVID-19 pandemic at an urban safety-net hospital, assess the impact of the pandemic on their SDoH, study the feasibility of SDoH screening and resource referrals, and identify preferred methods of resource referrals and barriers to accessing resources.Methods: Research assistants screened ED urgent care patients using a validated SDoH screener, inquiring about the impact of COVID-19 on their SDoH. A printed resource guide was provided. Two weeks later, a follow-up telephone survey assessed for barriers to resource connection and patients’ preferred methods for resource referrals. This study was deemed exempt by our institutionalreview board.Results: Of the 418 patients presented with a screener, 414 (99.0%) patients completed the screening. Of those screened, 296 (71.5%) reported at least one adverse SDoH, most commonly education (38.7%), food insecurity (35.3%), and employment (31.0%). Housing insecurity was reported by 21.0%. Over half of patients (57.0%) endorsed COVID-19 affecting their SDoH. During follow-up, 156 of 234 (67%) attempted calls were successful and 36/156 (23.1%) reported attempting to connect with a resource, with most attempts made for stable housing (11.0%) and food (7.7%). Reasons for not contacting the provided resources included lack of time (37.8%) and forgetting to do so (26.3%). Patients preferred resource guides to be printed (34.0%) and sent via text message to their mobile devices (25.6%).Conclusion: Many urgent care patients of this urban ED reported at least one adverse SDoH, the majority of which were exacerbated by the COVID-19 pandemic. This finding further emphasizes the need to allocate more resources to standardize and expand SDoH screening in EDs. Additionally, hospitals should increase availability of printed or electronic SDoH resource guides, resource navigators, and interpreters both during and after ED visits.

OBJECTIVE: To understand providers perceptions of how a patients experience of racism may impact the successful implementation of a brief posttraumatic stress disorder (PTSD) treatment in the safety net integrated primary care setting. To conduct a developmental formative evaluation prior to a hybrid type I effectiveness-implementation trial. DATA SOURCES AND STUDY SETTING: From October 2020 to January 2021, in-depth qualitative interviews were conducted with integrated primary care stakeholders (N = 27) at the largest safety net hospital in New England, where 82% of patients identify as racial or ethnic minorities. STUDY DESIGN: Interviews with clinical stakeholders were used to (a) contextualize current patient and provider experiences and responses to racism, (b) consider how racism may impact PTSD treatment implementation, (c) gather recommendations for potential augmentation to the proposed PTSD treatment (e.g., culturally responsive delivery, cultural adaptation), and (d) gather recommendations for how to shift the integrated primary care practice to an antiracist framework. DATA COLLECTION/EXTRACTION METHODS: Interview data were gathered using remote data collection methods (video conferencing). Participants were hospital employees, including psychologists, social workers, primary care physicians, community health workers, administrators, and operations managers. We used conventional content analysis. PRINCIPAL FINDINGS: Clinical stakeholders acknowledged the impact of racism, including racial stress and trauma, on patient engagement and noted the potential need to adapt PTSD treatments to enhance engagement. Clinical stakeholders also characterized the harms of racism on patients and providers and provided recommendations such as changes to staff training and hiring practices, examination of racist policies, and increases in support for providers of color. CONCLUSIONS: This study contextualizes providers perceptions of racism in the integrated primary care practice and provides some suggestions for shifting to an antiracist framework. Our findings also highlight how racism in health care may be a PTSD treatment implementation barrier.

Summary: Background: Ulcerative proctitis (UP) can have a milder, less aggressive course than left‐sided colitis or extensive colitis. Therefore, immunosuppressants tend to be used less in patients with this condition. Evidence, however, is scarce because these patients are excluded from randomised controlled clinical trials. Our aim was to describe the characteristics of patients with refractory UP and their disease‐related complications, and to identify the need for immunosuppressive therapies. Methods: We identified patients with UP from the prospective ENEIDA registry sponsored by the GETECCU. We evaluated socio‐demographic data and complications associated with immunosuppression. We defined immunosuppression as the use of immunomodulators, biologics and/or small molecules. We used logistic regression to identify factors associated with immunosuppressive therapy. Results: From a total of 34,716 patients with ulcerative colitis, we identified 6281 (18.1%) with UP; mean ± SD age 53 ± 15 years, average disease duration of 12 ± 9 years. Immunosuppression was prescribed in 11% of patients, 4.2% needed one biologic agent and 1% needed two; 2% of patients required hospitalisation, and 0.5% underwent panproctocolectomy or subtotal colectomy. We identified 0.2% colorectal tumours and 5% extracolonic tumours. Patients with polyarthritis (OR 3.56, 95% CI 1.86–6.69; p < 0.001) required immunosuppressants. Conclusions: Among patients with refractory UP, 11% required immunosuppressant therapy, and 4.2% required at least one biologic agent. [ABSTRACT FROM AUTHOR]

We analyze the potential economic impacts in Argentina of the European Union Deforestation Regulation (EUDR), which as of January 2025 will prohibit the export to the European Union of certain raw materials and related products if they involve the use of deforested land. A dynamic computable general equilibrium model is used to simulate the impact of such regulation on the Argentine economy. The results suggest that the potential macroeconomic impacts are limited. As a consequence of the EUDR, between 2025 and 2030, GDP would be reduced by an average of 0.46% with respect to the baseline scenario. However, of greater magnitude is the potential environmental impact. Deforested hectares would be reduced by 6.64% and polluting gas emissions by 0.39%. [ABSTRACT FROM AUTHOR]

The discovery that the actinobacterium Micromonospora inhabits nitrogen-fixing nodules raised questions as to its potential ecological role. The capacity of two Micromonospora strains to infect legumes other than their original host, Lupinus angustifolius, was investigated using Medicago and Trifolium as test plants. Compatible rhizobial strains were used for coinoculation of the plants because Micromonospora itself does not induce nodulation. Over 50% of nodules from each legume housed Micromonospora, and using 16S rRNA gene sequence identification, we verified that the reisolated strains corresponded to the microorganisms inoculated. Entry of the bacteria and colonization of the plant hosts were monitored using a GFP-tagged Lupac 08 mutant together with rhizobia, and by using immunogold labeling. Strain Lupac 08 was localized in plant tissues, confirming its capacity to enter and colonize all hosts. Based on studying three different plants, our results support a non-specific relationship between Micromonospora and legumes. Micromonospora Lupac 08, originally isolated from Lupinus re-enters root tissue, but only when coinoculated with the corresponding rhizobia. The ability of Micromonospora to infect and colonize different legume species and function as a potential plant-growth promoting bacterium is relevant because this microbe enhances the symbiosis without interfering with the host and its nodulating and nitrogen-fixing microbes.

Objective: The placement of a chest tube to resolve pleural effusion, pneumothorax or as a diagnostic method is a relatively common invasive procedure in the emergency room and hospitalization area, which is not inherent to presenting complications. We present the case of a patient with perforation of the left ventricle secondary to the placement of a chest tube Case presentation: A 76-year-old male who was admitted to the emergency department with pneumonia and left pleural effusion. A chest tube was placed in pleural space, however, after procedure hemodynamic deterioration occurred and computed tomography (CT) revealed left ventricular perforation. Thoracotomy was performed to remove the catheter and repair the left ventricular puncture site. Although due to hemodynamic instability patient was admitted to intensive care unit with mechanical ventilation, subsequently developed cardiogenic shock. Vasopressor support was needed. An echocardiogram was performed on day 1 after the surgical intervention and showed no evidence of bleeding according to the report. After three days the patient dies from cardiogenic shock. Conclusion: In conclusion, whenever available, it is better to use a chest CT prior to placement of the chest tube and during the procedure use lung ultrasound to guide the puncture. Special care must be taken when using small caliber probes. Finally, more publications of these complications are required to have more evidence in the management of these cases. Take home message: Special care must be taken when using small caliber probes. The efficacy of lung ultrasound in guiding chest tube placement, demonstrating it is utility in improving accuracy and reducing complications. [ABSTRACT FROM AUTHOR]

This paper estimates wage differentials between green and non-green jobs (wage greenium) in nine major Latin American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Peru and Uruguay), which account for 81% of the region's GDP. We contribute to the recent literature highlighting a positive wage gap for those working in green jobs in developed countries. A positive wage gap for green jobs may be a virtuous market feature, as it means that in the future workers might be encouraged to switch to greener occupations. To do so, we define green jobs as those occupations with high greenness scores using the occupational approach as in Vona et al. (2018), Vona (2021) and de la Vega et al. (2024). Our results suggest that the wage greenium for the period 2012-2019 in Latin America was between 18% to 22%. Moreover, this wage gap has remained relatively stable over the years. [ABSTRACT FROM AUTHOR]